Η χρησιμοποίηση μιας νέας χειρουργικής τεχνικής στην αντιμετώπιση των ενδοφυτικών θηλωμάτων της ρινός και των παραρρινίων κόλπων
Τερζάκης, Γεώργιος Δ
The inverted papilloma is a rate type of neoplasia, with an incidence of 0.5-4% of nasal tumours. The tumour spreads along tissues, causes bony destruction, often recurs after surgical excision and in some cases is present together with squamous cell carcinoma, showing an unpredictable behaviour. Its clinical presentation includes nasal obstruction, epistaxis, facial pain and symptoms mimicking those of the infections of the paranasal sinuses. Histologically, it is characterised by a hyperplastic respiratory epithelium with an exophytic or inverted pattern of growth and increased number of epithelial cells in the underlying stroma. Complete surgical excision is the treatment of choice and application of the optimal approach and technique is of the utmost importance. In cases of tumours of limited size a conservative resection is selected, while more extended tumours, filling the nasal cavity and the paranasal sinuses, demand a more aggressive procedure, such as a lateral rhinotomy incision with a medial maxillectomy. However, the patient has to face many functional problems post-operatively, because of the large space created by the operation. In our Department a new technique has been used the last twenty years for the surgical excision of inverted papillomas, as an alternative to the conventional approach. Using this new technique, we have the ability to radically excise the tumour while preserving the maximum of the healthy part of the external wall of the nasal cavity. As a result, we are able to create a normally functioning and restricted nasal cavity and to minimise, in the majority of cases, the disadvantages caused by the large cavity of the middle maxillectomy.